When the topic is health care system reform, doctors and policy-makers offer different assessments of the problem. To avoid any potential confusion, PT talked to Maine Senator Lisa Marrache, a practicing physician and Vice-Chair of the NCSL Health Committee.

PT: As a physician and a policy-maker, what would you point to as the guiding principles of a viable health care policy in the United States?

Senator Marrache: We need to focus on what would give us the greatest access to health care. It may be a blend of free-market principles and government action, but we need to be discussing what we want before we argue about how to get there. We should be guided by our objective, which it to make heath care accessible to everyone who needs it.

PT: Maine’s Dirigo Health Reform Act must have inspired the same kind of debate we’re seeing today at the federal level. Talk a little bit about the tenor of the debate leading up to the bill’s passage.

Senator Marrache: It was the same “free market” vs. “socialized medicine” argument that you always get when it comes to health care. The contentious point was based more upon the mechanism of paying for it, and not necessarily putting patients’ interests at the heart of the discussion. One side was angry that they’d be assessed a fee to pay for the program, while the other side touted our ability to lower the rate of uninsured in the state.

PT: Why don’t we ever hear the debate framed as an issue of equality? Isn’t this fundamentally a concern about equality in our society?

Senator Marrache: That’s true, but I think people avoid asking the question because some are afraid of the answer they might get.

PT: Outside of the obvious, what are the biggest failings of the current health care system in the United States?

Senator Marrache: The biggest failure is our constant argument over the funding mechanism. We waste so much time arguing about it and fighting lawsuits that we lose time we could better spend trying to make it work.

PT: Let’s talk about the structure of health care politics. Does it make a difference that the vast majority of registered voters come from the section of the population that has insurance, while many without coverage don’t vote? Does this fact alter the contours of the debate?

Senator Marrache: I think so. I had a 63-year-old patient this morning tell me, “I’ve got to do everything I can to stay healthy for two more years so I can get into Medicare.” And I hear this over, and over, and over. But those are also the people that tend not to vote for the same type of health coverage for others.

It’s interesting how legislators’ philosophies change once they get to the capitol. It’s difficult for many people to share that desire to help others when they’re not the ones who are hurting.

PT: It doesn’t help that we generally look at health care as this enormous, insurmountable crisis. How would you break up the issue into manageable subsections? Which portions represent the best opportunities for positive action?

Senator Marrache: We need to start putting the patient first. How can we get the majority of our people covered? Once we establish who is covered by different types of insurance, we need to isolate the gaps in coverage and examine why they exist. You hear a lot of people who think they know the answers, so they don’t want to discuss it any further. But maybe—just maybe—some market reforms that conservatives promote actually do work. Their adversaries might not like how these reforms work, but that doesn’t change their efficacy. On the other hand, some conservatives may not like “socialized medicine,” but look at Medicare and Medicaid. What’s the difference? We have to get people thinking differently.

PT: Because you’re a practicing physician, you must come at the issue from a somewhat different angle than your colleagues in the legislature. Do you sense a lack of understanding on the part of your colleagues when it comes to the practicalities of health care?

Senator Marrache: Yes, actually. I don’t think you really grasp it until you’re in a room listening to patients day after day. When you tell a patient that they need an MRI because you think they may have had a stroke or they might have an aneurysm, and you know they can’t afford it, that’s tough. You tell them they need it, but you end up trying to come up with the least-costly treatment that can help them when you know deep in your heart that what they really need is something they could never afford. If you’re not in a room listening to these stories, I don’t think you can quite understand it.

Lisa Marrache serves as vice-chair of the NCSL Health Committee. She is currently serving her first term in the Maine State Senate after three terms in the state’s House of Representatives. She is a practicing family physician.